High rate of major drug–drug interactions of lopinavir–ritonavir for COVID-19 treatment

AbstractThe impact of drug–drug interactions (DDI) between ritonavir-boosted lopinavir (LPV-r) to treat patients with coronavirus disease 2019 (COVID-19) and commonly used drugs in clinical practice is not well-known. Thus, we evaluated the rate and severity of DDI between LPV-r for COVID-19 treatment and concomitant medications. This was a cross-sectional study including all individuals diagnosed of SARS-CoV-2 infection treated with LPV-r and attended at a single center in Southern Spain (March 1st to April 30th, 2020). The frequency [95% confidence interval (95% CI)] of potential and major DDI were calculated. Overall, 469 patients were diagnosed of COVID-19, 125 (27%) of them were prescribed LPV-r. LPV-r had potential DDI with concomitant medications in 97 (78%, 95% CI 69–85%) patients, and in 33 (26%, 95% CI 19–35%) individuals showed major DDI. Twelve (36%) patients with major DDI and 14 (15%) individuals without major DDI died (p = 0.010). After adjustment, only the Charlson index was independently associated with death [adjusted OR (95% CI) for Charlson index ≥ 5: 85 (10–731), p < 0.001]. LPV-r was discontinued due to side effects in 31 (25%) patients. Management by the Infectious Diseases Unit was associated with a lower likelihood of major DDI [adjusted odds ratio (95% CI): 0.14 (0.04–0.53), p = 0.003). In conclusion, a high frequency of DDI between LPV-r for treating COVID-19 and concomitant medications was found, including major DDI. Patients with major DDI showed worse outcomes, but this association was explained by the older age and comorbidities. Patients managed by the Infectious Diseases Unit had lower risk of major DDI.

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High rate of major drug-drug interactions of lopinavir-ritonavir for COVID-19 treatment

10.1101/2020.07.30.20165027 ◽

2020 ◽

Author(s):

Juan Macias ◽

Ana Pinilla ◽

Francisco A Lao-Dominguez ◽

Anais Corma ◽

Enrique Contreras-Macias ◽

...

Keyword(s):

Infectious Diseases ◽

Drug Interactions ◽

High Frequency ◽

Cross Sectional Study ◽

Charlson Index ◽

High Rate ◽

Cross Sectional ◽

Concomitant Medications ◽

The Impact ◽

Major Drug

The impact of drug-drug interactions (DDI) between ritonavir-boosted lopinavir (LPV-r) to treat patients with coronavirus disease 2019 (COVID-19) and commonly used drugs in clinical practice is not well-known. Thus, we evaluated the rate and severity of DDI between LPV-r for COVID-19 treatment and concomitant medications. This was a cross-sectional study including all individuals diagnosed of SARS-CoV-2 infection treated with LPV-r and attended at a single center in Southern Spain (March 1st to April 30th, 2020). The frequency [95% confidence interval (95% CI)] of potential and major DDI were calculated. Overall, 469 patients were diagnosed of COVID-19, 125 (27%) of them were prescribed LPV-r. LPV-r had potential DDI with concomitant medications in 97 (78%, 95% CI: 69%-85%) patients, and in 33 (26%, 95% CI: 19%-35%) individuals showed major DDI. Twelve (36%) patients with major DDI and 14 (15%) individuals without major DDI died (p=0.010). After adjustment, only the Charlson index was independently associated with death [adjusted OR (95% CI) for Charlson index ≥5: 85 (10-731), p <0.001]. LPV-r was discontinued due to side effects in 31 (25%) patients. Management by the Infectious Diseases Unit was associated with a lower likelihood of major DDI [adjusted odds ratio (95% CI): 0.14 (0.04-0.53), p=0.003). In conclusion, a high frequency of DDI between LPV-r for treating COVID-19 and concomitant medications was found, including major DDI. Patients with major DDI showed worse outcomes, but this association was explained by the older age and comorbidities. Patients managed by the Infectious Diseases Unit had lower risk of major DDI.

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458. Diagnostic Accuracy and Management of Suspected Moderate to Severe Cellulitis Referred to an Infectious Diseases Outpatient Parenteral Antibiotic Clinic: A Prospective Cross-Sectional Study

Open Forum Infectious Diseases ◽

10.1093/ofid/ofz360.531 ◽

2019 ◽

Vol 6 (Supplement_2) ◽

pp. S225-S225

Author(s):

Jolanta Piszczek ◽

Eric Partlow ◽

Shay-Anne Daniels ◽

Milena Semproni ◽

Wayne Ghesquiere

Keyword(s):

Emergency Department ◽

Infectious Diseases ◽

Diagnostic Accuracy ◽

Cross Sectional Study ◽

High Rate ◽

Sectional Study ◽

Cross Sectional ◽

Parenteral Antibiotic ◽

Intravenous Antibiotics ◽

The Impact

Abstract Background Moderate to severe cellulitis is a common reason for presentation to the emergency department and administration of intravenous antibiotics. Misdiagnosis of cellulitis occurs frequently as the disease can masquerade as a wide variety of noninfectious and infectious problems. There are currently no studies evaluating the impact of infectious diseases physicians on the diagnostic accuracy and management of cellulitis referred to an outpatient parenteral antibiotic clinic from the emergency department. The objective of this study was to quantify the prevalence of misdiagnosed moderate to severe cellulitis through an evaluation by an infectious diseases specialist, characterize the alternative diagnoses, and assess variables associated with misdiagnosis. Methods A prospective cross-sectional study of adults referred from emergency departments with presumed moderate to severe cellulitis to an outpatient parenteral antibiotic clinic staffed by infectious diseases specialists. Results 301 consecutive patients with presumed cellulitis were evaluated over a 6-month period. A concurring diagnosis of cellulitis was found in 170 patients (56.5%), for a misdiagnosis rate of 43.5% (131/301). Table 1 summarizes the alternative diagnoses. Infectious conditions other than cellulitis were the most common (63/301; 20.9%), with abscess being present in 23 (7.6%) of patients. Fifty-two of 301 (17.3%) of the diagnoses were noninfectious and 16/301 (5.3%) patients had a dual diagnosis where minor cellulitis was present, but secondary to another, predomintating condition. The presence of stasis dermatitis (OR 6.62, P = 0.013) and a history of physical trauma (OR 1.76, P = 0.046) were associated with a misdiagnosis. 31.9% (107/335) of antibiotic regimens prescribed by emergency physicians were inappropriate or sub-optimal compared with 7.9% (22/280) of those ordered by infectious disease doctors. Conclusion Moderate to severe cellulitis was incorrectly diagnosed in nearly half of the patients referred for intravenous antibiotics and resulted in a high rate of unstewardly antimicrobial use. Infectious diseases physicians at an outpatient antibiotic clinic improved the diagnostic accuracy and management of this complicated condition. Disclosures All authors: No reported disclosures.

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Maternity handover in Kerala: a cross sectional study

International Journal of Community Medicine and Public Health ◽

10.18203/2394-6040.ijcmph20183560 ◽

2018 ◽

Vol 5 (9) ◽

pp. 3760 ◽

Cited By ~ 1

Author(s):

Aadil Sheikh ◽

Jessica Dunphy ◽

Claire Humphries ◽

Christina MacArthur ◽

Semira Manaseki-Holland

Keyword(s):

Healthcare Provider ◽

Tertiary Care ◽

Obstetric Care ◽

Tertiary Hospital ◽

Cross Sectional Study ◽

Community Health Services ◽

High Rate ◽

Sectional Study ◽

Cross Sectional ◽

The Impact

Background: The objective of the study was to explore the referral system from the community to hospital obstetric care in Kerala, India.Methods: Cross-sectional study. A total of 206 obstetric inpatients in 3 hospitals in Kerala, India completed an orally-administered questionnaire regarding referral and attitudes towards healthcare information.Results: Among 206 respondents, 19 (9%) had been referred from another healthcare provider. In multivariate analysis, referral was independently associated with being in a tertiary hospital (p<0.001). At total of 17 referred women received a document containing hand-written notes from their previous healthcare provider. Just 3 of the documents available to view were formal referral documents; others were test results and/or hospital notes. A total of 170 (86%) of the 206 women thought that receiving documents such as referral letters was important; mostly because it helped them understand their condition and explain it to others (91%).Conclusions: A high rate of self-referral (91%) was reported by obstetric inpatients. It appears that some women who are referred do not receive a formal referral document. Participants thought that receiving referral documents was important. A strong health system requires transfer of information between primary and secondary/tertiary care services, which India is seeking to develop. Further research is needed into why women are not accessing community health services and the impact of the content of referral documents on patient care.

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ASSESSMENT OF DRUG USE FOR INPATIENTS WHO WERE PRESCRIBED CEFTAZIDIME: A RETROSPECTIVE CROSS-SECTIONAL STUDY IN A DISTRICT-LEVEL HOSPITAL

Tạp chí Y học Việt Nam ◽

10.51298/vmj.v506i1-2.977 ◽

2021 ◽

Vol 506 (1-2) ◽

Author(s):

Nguyen Thi Thanh Huong ◽

Dinh Xuan Dai

Keyword(s):

Drug Use ◽

Drug Interactions ◽

Medical Records ◽

Cross Sectional Study ◽

District Level ◽

Sectional Study ◽

Broad Spectrum Antibiotic ◽

Cross Sectional ◽

Level Hospital ◽

Major Drug

In health facilities, there is a lot of public concern about the irrational use of medications, especially antibiotic misuse. This retrospective cross-sectional study was conducted to assess the utilization of medicines for inpatients using ceftazidime in treatment in a district-level hospital in Vietnam, using 396 medical records. The results showed that there were approximately 6.7 kinds of drugs prescribed for each inpatient, including roughly 1.23 antibiotics. On average, 5.69 days of hospitalization cost an inpatient about 74.31USD, including more than 20USD for medicines (9.22USD for antibiotics) and 54.27USD for other expenses. There were 19.70% of medical records in which found at least one drug-drug interaction. Cardiovascular medicines, corticoids, fluoroquinolones and proton-pump inhibitors were medicine groups involving many found drug-drug interactions. For ceftazidime, indications of this antibiotic were inappropriate for nearly half of inpatients. For 199 inpatients whose indications’ ceftazidime were appropriate, the route of ceftazidime administration was appropriate but its dose per day and dose duration were inappropriate. More importantly, ceftazidime was used with a dosage lower than the recommended dosage (98.99%). In conclusion, there were several problems involving drug use that should be addressed, including curbing major drug-drug interactions and the irrational use of ceftazidime, a watch-group, broad-spectrum antibiotic.

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IMPACT OF COVID-19 ON PREGNANCY OUTCOMES: A CROSS SECTIONAL STUDY

International Journal of Medical Science and Diagnosis Research ◽

10.32553/ijmsdr.v5i4.796 ◽

2021 ◽

Vol 5 (4) ◽

Author(s):

Farah Yousaf ◽

Sadaf Mubeen ◽

Amna Javaid ◽

Muhammad Aamir Rafique ◽

Hafiza Sobia Ramzan

Keyword(s):

Pregnancy Outcomes ◽

Demographic Data ◽

Local Population ◽

Fetal Distress ◽

Cross Sectional Study ◽

High Rate ◽

Atypical Pneumonia ◽

Cross Sectional ◽

Significant Difference ◽

The Impact

Introduction: Atypical pneumonia known as coronavirus disease (COVID-19), which is caused by the SARS-CoV-2 virus, is highly infectious and is currently spreading rapidly around the globe. Objectives: The main objective of the study is to analyses the impact of COVID-19 on pregnancy outcomes among local population of Pakistan. Material and Methods: This cross sectional observational study was conducted in Lady Aitchison Hospital during September 2019 to August 2020. The data was collected through systematically designed questionnaire. Clinical characteristics, examination results, and treatment course were extracted from their medical records. For mothers, we collected socio demographic data, educational attainment, and occupation, maternal parity, medical history records, laboratory tests, and intensive care unit [ICU] admission. Results: The data was collected from 685 patients. The two groups of pregnant women were compared in terms of severe preeclampsia, gestational diabetes, premature rupture of membranes, fetal distress, maternal mortality, IUD, fecal staining of amniotic fluid, premature birth, neonatal asphyxia, Abruption or other compression sutures, and there was no significant difference Significance (all P >0.05); the proportion of IUD in the COVID-19 group was higher than that in the non COVID-19 group, and the difference between the two groups was statistically significant. Conclusion: It is concluded that those patients who visited the hospital during COVID-19 pandemics have high rate of IUD, placenta abruption and maternal death. Keywords: IUD., COVID-19

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The Impact of Covid-19 on Medical Students: A Cross Sectional Survey

10.53350/pjmhs2115112905 ◽

2021 ◽

pp. 2905-2909

Author(s):

Rakesh Kumar ◽

Haresh Kumar ◽

Rakhi Kumari ◽

Jawed Dars ◽

Shahzaib Qureshi ◽

...

Keyword(s):

Medical Students ◽

Living Arrangements ◽

Online Survey ◽

Psychological Impact ◽

Cross Sectional Study ◽

High Rate ◽

P Value ◽

Cross Sectional Survey ◽

Cross Sectional ◽

The Impact

Aim: To understand the psychological impact of COVID – 19 on Medical Students of a private sector Medical University in Karachi, Pakistan. Method: This cross-sectional study was conducted among medical students studying at Hamdard College of Medicine and Dentistry, Karachi, Pakistan. The data collection was done through online survey from July 2020 to December 2020. The study aimed to gather data from many medical students. A total number of 420 students were participated from Hamdard College of Medicine and Dentistry in Karachi, Pakistan. The participants were selected from all years of MBBS and BDS programs . Results: Out of 420 participants, 236 (56.2%) were male and 184 (43.8%) female, with a male:female ration of 1.28:1. Majority of participants were single as 411 (97.9%), of 224 (53.3%) students living with their family, 150 (35.7%) in hostel and 46 (11%) living with friends. In our sample 369 (87.9%) students studying in MBBS program while only 51 (12.1%) BDS, among those 80 (19%) medical students were in first year, followed by 122 (29%) second year, 65 (15.5%) third year, 54 (12.9%) fourth year and 99 (23.6%) studying in final year. IES-R scale and results shows 75 (17.9%) reported that PTSD is a clinical concern, probable diagnosis of PTSD 28 (6.7%) and majority rated as high enough to PTSD 133 (31.7%). Impact of event (revised) scale shows significant association with age and year of study with p value 0.026 and 0.002 respectively. Based on the PHQ9 scale, Gender, Living arrangements and the program enrolled in were reported significant association with depression p values 0.059, 0.008 and 0.006 respectively. Conclusion: Findings suggests high rate of anxiety, depression, and signs of PTSD in medical students due to COVID-19 which needs pressing attention and provision of professional help from mental health practitioners. Keywords: Impact, Covid-19, Medical students

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Scope on Medication Errors during Pregnancy ina Sample Iraqi Two Cities Samawah & Diwania.

International Journal of Research in Pharmaceutical Sciences ◽

10.26452/ijrps.v9ispl1.1402 ◽

2018 ◽

Vol 9 (SPL1) ◽

Author(s):

Bassim I Mohammad ◽

Naryman Aziz Abass ◽

Ali Salman Juail

Keyword(s):

Drug Interactions ◽

Medication Errors ◽

Inappropriate Prescribing ◽

Cross Sectional Study ◽

The Body ◽

Sensitive Period ◽

Cross Sectional ◽

Inappropriate Use ◽

Two Cities ◽

The Impact

The pregnancy is sensitive period and administration of drugs may lead to threating of fetus life or cause malformations teratogenicity etc. A cross-sectional study of medication errors of 100 prescriptions dispensed to a pregnant women in a sample of Iraqi two cities (Sammawa & Diwania) during October,2016. The total number of medication errors identified was 364 (74%),included 110 irrational & inappropriate prescribing,47 over prescribing,19 under prescribing,and 8 ineffective prescribing errors. The drug interactions were classified to drug-drug interactions 126 interactions identified and drug food interactions 54 interactions was recorded. 0.8 % of all interactions was major,76 % moderate and 23% mild. Luminal (Phenobarbital) is the drug that caused the most of medication error that identified as it dispensed 23 times but all of these patient luminal was irrational and inappropriate and it caused the most of interactions recorded as 44 interactions was caused by luminal. While duphaston (Dydrogesterone) was prescribed 21 times,and this considered as irrational & inappropriate prescribing. Duvadilane (isoxsuprine) prescribed irrationally 17 times. The parenteral iron administered without sensitivity test nor calculating the dose depending on the body weight and blood Hb.Most of antibiotics and antifungal prescribed for incorrect duration or dose. The other errors were related to other drugs duration,dose and indication errors. Percentage of medication errors were high. Types of medication errors were mostly drug-drug interaction,irrational and inappropriate use. The impact of these medication errors may include teratogenic effect.

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Medication Reconciliation and Drug–Drug Interactions: An Old Process with a New Approach

Journal of Pharmaceutical Care ◽

10.18502/jpc.v9i1.6035 ◽

2021 ◽

Author(s):

Shahram Ala ◽

Sufia Tonkaboni ◽

Aliyeh Bazi ◽

Ebrahim Salehifar

Keyword(s):

Drug Interactions ◽

Medication Reconciliation ◽

Cross Sectional Study ◽

High Rate ◽

Cross Sectional ◽

New Approach ◽

Drug History ◽

North Of Iran ◽

History Of ◽

Hospital Wards

Background: The occurrence of drug–drug interactions (DDIs) and insufficient attention to medication reconciliation is one of the important challenges of pharmacotherapy in hospitalized patients. The aim of this study was to determine the extent of drug–drug interactions in patients based on medication reconciliation strategy. Methods: This descriptive cross-sectional study was performed for six months in patients admitted to Imam Reza Hospital in Amol, North of Iran. The data were obtained by using a medication reconciliation tool through a random sampling of patients admitted in Hospital wards from May 2014 until October 2014. A total of 200 patients were enrolled in the study. All patients had a history of medication use before admission. The drug interactions have been checked according to Drug Interaction Facts between newly prescribed drug and medication patient using before admission. The number and frequency of data were summarized by SPSS21 statistical software. Results: Major and Moderate DDIs were found in 7.5% and 64% of prescriptions. The most frequent DDIs were seen in those who were taking psychiatric drugs (33%) and cardiovascular drugs (30%). Most DDIs occurred among women over 60 years of age. The most frequently occurring DDIs was pharmacokinetics interaction between clopidogrel and atorvastatin (n=9). Other frequent interactions were between ceftriaxone and heparin (n=8) and metoprolol and insulin (n=3). Conclusion: This study showed a high rate of drug interactions and especially confirms the importance of medication reconciliation in providing a comprehensive drug history and exploring drug interactions.

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Multidisciplinary team decision is rare and decreasing in percutaneous vascular interventions despite positive impact on in-hospital outcomes

VASA ◽

10.1024/0301-1526/a000771 ◽

2019 ◽

Vol 48 (3) ◽

pp. 262-269 ◽

Cited By ~ 3

Author(s):

Christian-Alexander Behrendt ◽

Tilo Kölbel ◽

Thea Schwaneberg ◽

Holger Diener ◽

Ralf Hohnhold ◽

...

Keyword(s):

Multidisciplinary Team ◽

Positive Impact ◽

Cross Sectional Study ◽

Invasive Treatment ◽

Cross Sectional ◽

Hospital Outcomes ◽

Vascular Intervention ◽

Medical Specialties ◽

Team Decision ◽

The Impact

Abstract. Background: Worldwide prevalence of peripheral artery disease (PAD) is increasing and peripheral vascular intervention (PVI) has become the primary invasive treatment. There is evidence that multidisciplinary team decision-making (MTD) has an impact on in-hospital outcomes. This study aims to depict practice patterns and time changes regarding MTD of different medical specialties. Methods: This is a retrospective cross-sectional study design. 20,748 invasive, percutaneous PVI of PAD conducted in the metropolitan area of Hamburg (Germany) were consecutively collected between January 2004 and December 2014. Results: MTD prior to PVI was associated with lower odds of early unsuccessful termination of the procedures (Odds Ratio 0.662, p < 0.001). The proportion of MTD decreased over the study period (30.9 % until 2009 vs. 16.6 % from 2010, p < 0.001) while rates of critical limb-threatening ischemia (34.5 % vs. 42.1 %), patients´ age (70 vs. 72 years), PVI below-the-knee (BTK) (13.2 % vs. 22.4 %), and rates of severe TASC C/D lesions BTK (43.2 % vs. 54.2 %) increased (all p < 0.001). Utilization of MTD was different between medical specialties with lowest frequency in procedures performed by internists when compared to other medical specialties (7.1 % vs. 25.7 %, p < 0.001). Conclusions: MTD prior to PVI is associated with technical success of the procedure. Nonetheless, rates of MTD prior to PVI are decreasing during the study period. Future studies should address the impact of multidisciplinary vascular teams on long-term outcomes.

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